NY Initiative Improves Clozapine Prescribing in Medicaid Patients With Schizophrenia

The proportion of new clozapine trials for Medicaid patients with schizophrenia, among all new outpatient antipsychotic trials, increased 40% between 2009 and 2013 in New York state, following a multifaceted state initiative aimed at educating clinicians, patients, and their families about the benefits of this particular antipsychotic medication and providing support to clinicians in its use.

The largest gains occurred in state-operated clinics, according to a report by representatives from the New York State Office of Mental Health (NYSOMH) in Psychiatric Services in Advance.

Clozapine has been shown to be the most effective antipsychotic for treatment-resistant schizophrenia, yet clinicians have been reluctant to use it for a host of reasons. In 2010, NYSOMH introduced the “Best Practices Initiative—Clozapine” to promote the evidence-based use of clozapine in state-operated facilities. The initiative engaged academic partners at New York state research institutions and clinical leaders from state-operated psychiatric centers. NYSOMH also partnered with the Center for Practice Innovation at the New York State Psychiatric Institute to create interactive, Internet-based educational programs to provide information about clozapine to consumers, family members, and clinicians.

A retrospective, longitudinal study of patterns of new antipsychotic starts for individuals identified by Medicaid data as having schizophrenia revealed 115,320 “new starts” of antipsychotics between 2009 and 2013. The percentage of clozapine new starts among all new antipsychotic trials increased from 1.5% in 2009 to 2.1% in 2013, according to the report.

In comments to Psychiatric News, coauthor Lloyd Sederer, M.D. (pictured above), chief medical officer of the NYSOMH, said that the success of the initiative is due to a multifaceted campaign that includes clinician and patient education, a telephone consultation service in which clinicians can call clinical experts with questions, and regular monitoring and performance improvement at state facilities, among other activities.

“We believe this initiative can be successful in other areas of the country, but it’s not a one-shot deal,” Sederer said. “It’s a matter of leadership taking this on and sustaining a clinical performance improvement campaign.”

For related information, see the Psychiatric News article “Why Won't Clinicians Use Clozapine Despite Proven Superiority?”

(Image: Lloyd Sederer, M.D.)